Classification & Assessment in Psychiatry · Paper A
Body dysmorphic disorder
Body dysmorphic disorder (BDD) matters because it causes intense suffering over a flaw that other people cannot actually see, or see as only minor. It is a preoccupation with one or more perceived defects in appearance that is not observable, or appears only slight, to others. For example, imagine a young man convinced his nose is grotesquely disfigured, spending hours a day checking mirrors, when friends and family genuinely cannot see any abnormality at all. In practice, recognising that the perceived flaw is disproportionate to reality is the first step toward the diagnosis.
BDD sits in the OCDObsessive-compulsive disorder, a condition of unwanted repeated thoughts and the actions done to relieve them.Read more → (obsessive-compulsive disorder)-related group of conditions, sharing repetitive, ritualised behaviours such as mirror checking, camouflaging the perceived flaw with make-up or clothing, and repeatedly seeking reassurance. InsightA person's awareness and understanding that they are unwell and need help.Read more → varies widely: some patients recognise the belief may be excessive, while others hold it with full delusionalRelating to a fixed false belief held with total conviction despite evidence against it.Read more → conviction and reject that possibility entirely. Suicide risk is markedly elevated in BDD, higher than in many other psychiatric conditions, so risk assessment is essential at every review. Picture a patient who has already sought multiple cosmetic surgeries for a 'flaw' that surgeons cannot identify, and is now expressing hopelessness. In practice, that pattern of repeated unsuccessful cosmetic procedures plus hopelessness should prompt an urgent risk assessment.